Is It Possible to Perform EMR in Poorly Differentiated Type of Early Gastric Cancer?

Abstract

Is it possible to perform EMR in poorly differentiated type of early gastric cancer? Background: Poorly differentiated type of early gastric cancer was not included absolute indication of endoscopic mucosal resection (EMR). However, studies have shown that the lymph node metastasis with poorly differentiated type of mucosal gastric cancer less than 30 mm without histologic ulceration or lymphatic-vascular invasion is extremely low. Aims: This study evaluated the clinical usefullness and limitation of EMR in poorly differentiated type of early gastric cancer. Subjects & Methods: Between February 2001 and September 2004, EMR with conventional method (conventional EMR, n = 4), EMR using cap (EMRC, n = 2) or endoscopic incision and submucosa dissection (EISD, n = 18) were performed on 24 poorly differentiated type of early gastric neoplasm (M:F = 11:13, mean age: 52.76). En bloc resection, complete resection rate, recurrence and additional therapy were evaluated. Results: 1) The en bloc resection and complete resection rate were 77.7% (7/9), 77.7% (7/9) for lesions 10 mm or less in size and 85.7% (6/7), 71.4% (5/7) between 11 and 20 mm, 75% (6/8), 37% (3/8) between 21 and 30 mm Total enbloc and complete resection rate were 79.2% (19/24) and 62.5% (15/24) 2) Complete resection rate according to location of tumor was not significantly differentiated 3) Minor bleeding including oozing occurred in 16.6% (4/24). Perforation occurred in 0% (0/24) 4) 15 cases with completely resected intramucosal cancer have been followed for a median of 15.5 months (range: 3-37 months) without recurrence 9 cases of incompletely resected lesions were 6 with vertical margin positive including submucosal invasion, 7 with lateral margin positive, 4 of both positive 4 cases with 6 with vertical margin positive underwent surgery and 1 of 6 was followed for 26 months without recurrence 2 of 3 with lateral margin positive was treated by destructed therapy argon plasma coagulation after repeated biopsy was not malignancy and 1 underwent surgery. Conclusion: Poorly differentiated type of intramucosal cancer without lymphatic-vascular invasion less than 2 cm in a diameter may be included by indication of EMR.